Nearly 1 in 4 teen girls hurt themselves last year, the CDC reports, as ‘Sharp Objects’ tackles the taboo topic of non-suicidal self injury.
Samantha Puc hasn’t cut herself in 12 years, but the temptation still crosses her mind.
“Recovery isn’t something that’s neat and tidy. It’s an ongoing process,” the Rhode Island self-harm survivor, 28, told Moneyish. She started non-suicidal self-injury (NSSI) when she was 14 as a response to emotional trauma. “Cutting made me feel in control of myself, because I could point to a mark on my arm and say why and how it hurts,” she said. “Emotional pain isn’t like that.”
So she was worried about how HBO’s “Sharp Objects” would depict Golden Globe winner Amy Adams as a problem drinker who has carved words all over her body to deal with family trauma. And her character’s mother (Patricia Clarkson) pulls out her eyelashes in distress. But while the subject matter is shocking, Puc is relieved that the series hasn’t exploited it for shock value so far. There’s been one potentially triggering flashback scene of Adams cutting herself, but Puc says the showrunners have been mindful in how they reveal her physical and emotional scars.
“Frankly, this is the first time in a long time that I can recall something responsibly handling self-harm outside of fan-fiction,” said Puc. “It’s a topic that so many people get wrong.” For instance, “13 Reasons Why” was slammed by much of the mental health community for glamorizing suicide, as the main character posthumously recounts why she killed herself by sending her classmates a series of cassette tapes blaming them. There were 1.5 million more suicide-related Google searches than expected in the 19 days after “13 Reasons Why” debuted last year, Today.com reported.
But so far, mental health professionals haven’t criticized “Sharp Objects” the same way — although it should be noted that the show isn’t targeted to teens, and you need a premium HBO subscription to watch it, unlike the Netflix series. “I do think reading ‘Sharp Objects’ [the novel by “Gone Girl” author Gillian Flynn that the show is based on] or watching a miniseries with such vulnerable content may be tough to someone who either still struggles with these demons or has recently stopped self-harm behaviors,” Jennifer Aline, a freelance writer who’s recovered from self-injury told Moneyish. “However, during my darkest days, I did seek out books and shows that had characters I could relate to. It depends on the person, their personal struggle and their mindset … ‘Sharp Objects’ was a tough read, but a necessary one.”
Non-suicidal self-injury, which can include cutting, burning, scratching, pulling out hair, bruising or breaking bones without intending to kill oneself, stayed under wraps in the ’90s and early 2000s. But now more open conversations are addressing the subject thanks in part to shows like “Sharp Objects.” Shirley Manson, lead singer of the electronic pop band Garbage, also shared her self-harm history in a recent New York Times op-ed. “I was suffering from extreme ‘impostor syndrome,’” she wrote. “In hysterical, extreme moments, I thought if I could just get my hands upon a tiny little knife it would bring some relief and I would be able to handle the stress.”
Dr. Mary Ann Robinson, a captain at the Substance Abuse and Mental Health Services Administration (SAMHSA), added that “we’re at a place in time where people feel more comfortable sharing a bit more about their internal struggles.” Some others are only just now realizing that they were engaging in self-harm all along, such as punching a wall in distress. So as they come forward with their stories, “this is normalizing those who have been self-injuring,” she explained, making it even easier for the next person to share.
“It is definitely showing up in mainstream media,” agreed Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery. “We started to see an uptick in the early 2000s, with movies like ‘Thirteen’  and ‘Secretary’  depicting cutting, but it’s really started showing up on television within the last five years, notably with ‘13 Reasons Why.’”
But just because people weren’t talking about self-harm before doesn’t mean it wasn’t happening. An alarming new study just published in the American Journal of Public Health found that one in four teen girls hurt themselves on purpose during the past year without intending to die. The number of U.K. teens reporting self-injury has risen more than 70% in five years, the National Health Service recently reported.
And there’s a lot of misinformation about self-harm. The National Alliance on Mental Illness (NAMI) notes that this isn’t a mental illness, for example, but rather “a behavior that indicates a lack of coping skills” often associated with borderline personality disorder, depression, anxiety or post-traumatic stress disorder. And a person who self-harms usually does not mean to kill himself or herself, according to the Cornell Research Program for Self-Injury Recovery. In fact, many people recover, often through counseling and group therapy, Dr. Robinson said.
In Ruth Carter’s case, scratching the skin between the toes during college and grad school became part of her morning routine. “I’d sit down at my computer, check my email, put one of my feet up on the chair — and scratch until I started to bleed,” said Carter, 38, who has been in recovery for several years. “People think that cutters are either suicidal or they want to get caught — but you don’t want to get caught. This was something that was working for me, and I didn’t want to be told that I had to stop.”
But studies measuring the economic impact of self-injury often lump incidents together with suicides and suicide attempts. A recent Oxford study estimated the hospital costs of assessing and treating self-harm in England, including suicide, run $213 million a year. NAMI has warned that the United States economy loses $200 billion annually to untreated psychiatric conditions.
So while media attention can help shed that stigma, there’s a fine line between education and encouraging self-harm, as the “13 Reasons Why” backlash showed. “Oftentimes those who are trying to do these kinds of stories are hoping to bring public awareness to a problem, and that has to be balanced against the risk of inadvertently promoting the behavior that is being depicted,” Dr. Richard McKeon from SAMHSA told Moneyish.
Baily Alderson, 20, who used self-injury in high school to deal with her abusive father, was hospitalized after a suicide attempt when she was 17. She criticized “13 Reasons Why,” too, and said watching it made her uncomfortable. “People were going crazy on the internet, listing ‘Who would be the 13 people on your tapes?’ You’re romanticizing suicide that way,” she said.
So the second season of “13 Reasons Why” has addressed these concerns by adding content advisories before every episode, along with PSAs after each episode directing viewers to the free and confidential 24/7 Crisis Text Line (text REASON to 741741) and the National Suicide Prevention Lifeline (1-800-273-8255). “Sharper Objects” steers viewers to the SAMHSA hotline [1-800-662-HELP] and www.hbo.com/sharp-objects/resources for additional resources at the end of each episode.
“Anyone in the audience could be triggered (to hurt themselves) even by very responsible storytelling, but the fact of the matter is, most of the time, executives don’t seem to care whether they’re doing things right or not,” said Puc. “It’s OK to mess up, but (producers) need to listen and make changes when they do.”
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